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Comparative Study
. 2013 Aug 13;81(7):614-8.
doi: 10.1212/WNL.0b013e3182a08f07. Epub 2013 Jul 12.

Comparison of the response to endovascular reperfusion in relation to site of arterial occlusion

Robin Lemmens  1 , Michael Mlynash, Matus Straka, Stephanie Kemp, Roland Bammer, Michael P Marks, Gregory W Albers, Maarten G Lansberg
Affiliations
Comparative Study

Comparison of the response to endovascular reperfusion in relation to site of arterial occlusion

Robin Lemmens et al. Neurology. .

Abstract

Objective: We explored the relationship between the site of vascular occlusion and the response to endovascular treatment in patients with acute ischemic stroke and also considered the impact of mismatch profile.

Methods: DEFUSE-2 was a prospective cohort study of patients treated with endovascular therapy. Patients with internal carotid artery (ICA) and middle cerebral artery (MCA) involvement were included in this substudy. Mismatch and reperfusion status was assessed on MRI. Favorable clinical response was defined as an improvement of at least 8 points on the NIH Stroke Scale.

Results: Reperfusion rates were comparable in both groups (61% for ICA and 59% for MCA). In the setting of reperfusion, percentages of favorable clinical response were similar between patients with stroke due to ICA (65%) and MCA (63%) occlusions. When reperfusion was not achieved, favorable outcomes were less frequent with obstructions of the ICA (9%) than the MCA (52%). Among target mismatch patients, the adjusted odds ratio for favorable clinical response associated with reperfusion was 39.7 (95% confidence interval 1.4-1,132.8) for ICA occlusions vs 5.1 (95% confidence interval 1.4-19.3) for MCA occlusions.

Conclusions: Endovascular reperfusion is associated with favorable clinical response regardless of the location of the arterial occlusion. This association is strongest for target mismatch patients with ICA occlusions. Target mismatch patients with either ICA or MCA occlusions appear to be good candidates for endovascular reperfusion therapy.

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Figures

Figure
Figure. Functional outcome at 3 months in target mismatch patients stratified by site of arterial occlusion and reperfusion status
(A) In the DEFUSE-2 cohort, reperfusion was associated with a statistically significant shift in the distribution of outcomes on the mRS score at 3 months in target mismatch patients with ICA occlusions (p = 0.005). (B) There is a favorable trend that does not reach statistical significance in the target mismatch patients with MCA occlusion (p = 0.3). DEFUSE-2 = Diffusion Weighted Imaging Evaluation for Understanding Stroke Evolution–2; ICA = internal carotid artery; MCA = middle cerebral artery; mRS = modified Rankin Scale.
See this image and copyright information in PMC

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